Why Harm Reduction Makes Sense: These Three Things I Know are True

Harm reduction is the concept of reducing the dangers of drug and other substance use, including the damage due to addiction. While this seems perilously radical -- opponents claim it encourages drug use by "sending the wrong message" -- it is simply a recognition of undeniable truths about Americans and the entire human species. Here are three things about human beings that nobody can deny.

People will always use psychoactive substances. While the drug czar applauds small drops in teen drug use in the United States, there is no question that a sizable minority of American youth take illicit drugs and, by the time they are 20, a majority drink. Moreover, illicit use of legally-produced pharmaceuticals is the fastest growing form of drug abuse.

The 2008 Monitoring the Future survey of high school seniors found that marijuana remains the most popular drug (a third have smoked marijuana in the last year), but that illicit use of prescription drugs -- pain killers, tranquilizers, ADHD drugs, and others -- continues to grow rapidly.

Where do they find these drugs? Forty percent extend prescriptions they obtained legitimately. Other of these drugs come from family medicine cabinets. It is impossible to cut off these sources.

Of course, young people mainly drink for pleasure -- 43% of seniors drank in the last month. What is most frightening is that much of this comprises binge drinking, and these figures increase substantially as young people approach the age of 21, when about half binge drinking monthly or more frequently.

What are the chances of stamping out illicit drugs? What are the chances of reducing the growing illicit use of pharmaceuticals? What are the chances of eliminating underage drinking and bingeing? None of these things will ever happen. And chances are we will never see all three even decline at one time.

By the way, aiming at reducing underage binge drinking is not the same thing as reducing underage drinking. The first would be called harm reduction, because it recognizes that continued drinking will occur, while trying to reduce the amount of alcohol consumed and the danger that results from young people's bingeing.

Most addicts, alcoholics, and substance abusers will not quit using. Some of these young drinkers and drug users actually have a clinical condition called "substance abuse" or "substance dependence" (a quarter of 21-year-olds). Of course, young people should quit using these substances before reaching this point, or certainly after they achieve it.

But how many adult substance abusers abstain? By now, we are inured to the frequent visits to rehab by problem drinking and drug abusing entertainment figures (fill in your own favorites). There are even more prominent examples -- like the president of the United States, who still occasionally smokes after giving up his regular habit.

Obviously, the father of small daughters shouldn't be smoking at all. Just as obviously, the president of the United States, a role model for millions, should never be seen puffing on a cigarette. On the other hand, president elect Obama claims that he has drastically cut back his smoking, and this has made him healthier.

And, you know, he's right. Everybody should be perfect, but all of us fail at that goal, and people addicted to substances trying to go straight fail more often than average at perfection. But they can still do better by reducing their use, reducing their problematic use (like binge drinking), and staying safer while continuing to use (say, by avoiding drunk driving or using clean needles or taking drugs without injecting them). For the time being, that is probably the best that most can hope for.

The Platonic goal of eliminating all substance use is not only zany, it is unhealthy. Drinking alcohol is good for people at risk for heart disease - it makes them live longer on average. And, of course, we certainly aren't prepared to eliminate all pharmaceuticals -- they were invented to help people. Trying to ban all substance use, like the prohibition of alcohol in the United States, also creates its own problems -- crime, disregard for law, surreptitious and binge drinking, unregulated alcohol supplies and as a result alcohol poisonings, etc.

Where does all of this leave us? Zero tolerance goals -- having everyone join and stick to Alcoholics Anonymous, making all kids totally clean, eliminating all illicit drug supplies -- are each more unrealizable than the other. And we all know it.

Let's just hope that the harm reducer in chief and whomever he selects to be his drug czar are two such people living in the real world we all occupy.